Home > In The News > Antacids, Reflux and Bone loss
Short-Term Relief…..Long-Term Consequences
In more ways than one, this title describes the results of many pharmaceuticals that are routinely recommended and widely used throughout the United States. One of the most recommended medication categories in the U.S. are those intended to suppress the production of stomach acid. The most popular are either proton-pump inhibitors (brands include Prilosec® , Prevacid®, Nexium®), or Histamine2 (H2) receptor antagonist (brands include Tagemet®, Zantac®, Pepcid®). These drugs have been considered "miracle-drugs", able to reduce acid production and relieving millions of the pain associated with stomach ulcers and gastro-esophageal reflux disease (GERD). But what are the long-term health consequences to shutting off acid production?
For many years it has been known that stomach acid helps the digestion and absorption of many critical nutrients. Calcium, in particular, becomes very insoluble (reducing absorption) when acid levels drop and stomach pH is increased. Long-term use of acid-blocking drugs, therefore, could lead to a chronic reduction in calcium absorption (among other things), which may increase risk of bone mineral density loss and fractures. This was in fact published late last year in JAMA [Pub Med]. A nested case-control study, using the General Practice Research Database (1987-2003, patients in U.K.) found a clinically significant increase in hip fracture risk associated with both increasing dose and increasing duration of consumption of proton-pump inhibitors (PPI). After adjusting for numerous other factors that could increase fracture risk, PPI therapy of more than one year was associated with an additional 44% increase risk for hip fracture; while long-term high dose therapy was associated with a 165% increase in hip fracture risk. These authors also reported a smaller, but significant increased risk of hip fractures related to long-term use of H2-antagonist (adjusted odd ratio 1.3).
This is important information to understand since many individuals will be taking one of these OTC or prescription medications, and at the same time attempting to take supplements (or drugs) to prevent osteoporosis. Additionally, using the same database, a different group of researchers noted that the use of gastric acid suppressive agents was associated with a significant increased rate of Clostridium difficile- associated disease [Pub Med]. It is thought that stomach acid is one of the main defenses against ingested pathogens and reducing acid production may remove this benefit. One could ask how many other consequences will we discover related to long-term suppression of stomach acid.
Proton pump inhibitors reduce gallbladder function. Surg Endosc. 2006 Sep;20(9):1364-7.
Proton pump inhibitors reduce the bioavailability of dietary vitamin C. Aliment Pharmacol Ther. 2005 Sep 15;22(6):539-45.
Proton pump inhibitors and acute interstitial nephritis. Clin Gastroenterol Hepatol. 2006 May;4(5):597-604.
Review article: proton pump inhibitors and bacterial overgrowth. Aliment Pharmacol Ther. 2006 Jan 1;23(1):3-10.
Curcuma longa extract protects against gastric ulcers by blocking H2 histamine receptors. Biol Pharm Bull. 2005 Dec;28(12):2220-4.
In vitro susceptibility of Helicobacter pylori to botanical extracts used traditionally for the treatment of gastrointestinal disorders. Phytother Res. 2005 Nov;19(11):988-91.
A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006 Aug;51(8):1307-12.
Acupuncture for functional gastrointestinal disorders. J Gastroenterol. 2006 May;41(5):408-17.
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